Study: Many will die if Medicaid is not expanded

New report says thousands of uninsured will go without medical tests and treatments

January 30, 2014|By Tim Darragh and Steve Esack, Of The Morning Call

The Corbett administration's decision not to expand Medicaid under the new federal health-care law will result in an additional 400-1,500 deaths in Pennsylvania a year, nearly 13,000 additional families with catastrophic medical expenses and tens of thousands of cases of untreated depression, diabetes and missed screening tests, according to a study published Thursday.

Gathered by researchers from Harvard University and the City University of New York, the estimates show that in the states that opted out of expanding Medicaid, 7,000-17,000 additional deaths will occur among people who would have been covered had expansion been supported.

"We predict that many low-income women will forego recommended breast and cervical cancer screening; diabetics will forego medications and all low-income adults will face a greater likelihood of depression, catastrophic medical expenses and death," researchers wrote in the study, which was released on the website of the journal Health Affairs.

"We calculated the number and characteristics of people who will remain uninsured as a result of their state's opting out of the Medicaid expansion, and applied these figures to the known effects of insurance expansion from prior studies," lead author Samuel Dickman said. "The results were sobering. Political decisions have consequences, some of them lethal."

Expanding Medicaid, the state-federal health insurance program for certain poor and disabled people, was written into the Affordable Care Act and the federal government sweetened the deal by offering to pay for expansion for several years, requiring the state to kick in 10 percent by 2018. But the U.S. Supreme Court ruled that states had the option of accepting the expansion, and Pennsylvania, along with 24 other states, said no.

Without Medicaid expansion, hundreds of thousands of poor people in Pennsylvania won't have health insurance because they won't qualify for subsidies to help them pay for coverage under Obamacare. Under the existing regulations, they don't qualify for Medicaid either, leaving them with no insurance options.

The Corbett administration has proposed an alternative plan to expand Medicaid, although it includes a work requirement that federal officials have rejected in the past, as well as new premiums and co-payments for the poor.

A spokeswoman for the state Department of Public Welfare, which oversees the Medicaid program in Pennsylvania, said the department would offer no comment about the study until Friday.

According to the study, which Dickman said was conducted independently, about 7.8 million people remain uninsured in the 25 states that did not expand Medicaid. Pennsylvania's share is 435,000 people.

As a result, the study says, nearly 40,000 Pennsylvanians will not receive treatment for depression each year, 23,625 diabetics will go without medication and tens of thousands of women will forgo mammograms and pap smears. There also will be an additional 12,780 cases of people stuck with "catastrophic" medical expenses, it said.

Dickman said other studies have looked at the financial consequence of forgoing the Medicaid expansion. For example, a RAND Corp. report last year said the federal government would have injected $2 billion this year into Pennsylvania if the state accepted the expansion plan as proposed under Obamacare.

This new study, Dickman said, is the first to look at the health effects of opting out.

Based on the experiences of other states that had widened their Medicaid nets before the Affordable Care Act, the rates of death and illness in Pennsylvania would decline immediately if Medicaid were expanded, Dickman said.

"There was a mortality drop in year one and the overall mortality drop was greatest in year five," he said.

Those studies didn't look past the first five years of expanded Medicaid, he said.

The Harvard-CUNY study had several limitations, including that its data of uninsured people differed slightly from the Congressional Budget Office report often used as the baseline for studies. Also, the researchers said benefits in the federal health-care law may improve access to care more than observed in Oregon and other comparison states where Medicaid was expanded.

Antoinette Kraus, director of the Pennsylvania Health Access Network, said the new study supports the network's position that Medicaid expansion would be the state's best option.

"Expansion through Medicaid would allow hundreds of thousands of workers to finally have access to quality, affordable health insurance," she said. "It would also save taxpayers $522 million in 2014 and keep us on track to create 35,000 new, good-paying jobs."